Medication in rehab is one of those topics that can turn a family into two opposing camps overnight. One side says medication is essential, because addiction is a medical condition and withdrawal is dangerous. The other side says medication is just swapping one substance for another. Both sides can be right depending on what medication is being used, why it is being used, and how it is managed.
The problem is that families often don’t ask the right question. They ask, are you giving my loved one medication, as if medication itself is the issue. The real question is, what is the medication for, what is the plan, and does it support behaviour change or does it delay it.
In South Africa, this conversation is complicated by stigma, by fear, by the casual availability of certain sedatives, and by the fact that many people have been “treated” for addiction at home with a handful of pills and a promise to rest. That is not treatment. That is an attempt to silence symptoms while leaving the addiction system intact.
Medication can be life saving in rehab. It can also become a cover for a weak programme that doesn’t do enough psychological work. Families need clarity, not assumptions.
Withdrawal management is not optional
The first place medication matters is detox. Withdrawal is not always a gritty “push through it” experience. Alcohol withdrawal can be medically serious. Benzodiazepine withdrawal can be dangerous. Severe withdrawal symptoms can include seizures, delirium, and intense physiological stress. In these cases, medication is not a luxury and it is not indulgence. It is stabilisation.
A good rehab centre treats withdrawal with respect. They monitor symptoms, manage risk, and support sleep and hydration. Medication in detox should have a clear purpose, to reduce medical risk, reduce severe symptoms, and stabilise the person enough to engage in therapy. The goal is not to sedate someone into silence. The goal is to keep them safe.
Families often fear that medication during detox means the person is being drugged. That fear is understandable, but it often comes from misinformation. Properly managed detox uses medication in a controlled, time limited way to reduce risk. Unmanaged detox can lead to relapse quickly because the person becomes desperate for relief.
The question families should ask is not “are you giving meds,” but “what are you using, for how long, and how are you monitoring risk.”
Medication for mental health can reduce relapse risk
A significant number of people who use substances are self medicating. They may have anxiety, depression, trauma symptoms, mood instability, or untreated ADHD traits that existed before the addiction. Substances became their coping tool. When substances are removed, those symptoms often become louder.
This is where medication can help. If someone has significant depression that makes daily functioning difficult, appropriate treatment can reduce relapse risk because the person is less likely to reach for substances as emotional relief. If someone has severe anxiety that triggers cravings and panic, addressing that anxiety can help the person stay stable while they build coping skills. If someone has mood instability that makes them impulsive and reckless, stabilising mood can support behaviour change.
Medication alone does not cure addiction. But untreated mental health symptoms can sabotage recovery. A good programme screens for mental health issues and builds a plan that might include therapy, skill development, and medication when appropriate.
Families often want a single explanation, either addiction is a moral problem or a medical problem. Reality is messier. Addiction is behavioural and neurological, and mental health can be part of the driver system. If you ignore mental health, you often ignore the reason the person used in the first place.
The “just medicate them” trap
Families often fall into the “just medicate them” trap because medication feels practical. It feels like action. It feels like something you can control. It also feels less disruptive than rehab, because you can medicate someone at home and pretend life is normal. This is especially common when families are ashamed or when the person is still functioning enough to avoid obvious crisis.
The trap is that medication can reduce symptoms without changing behaviour. If the person is still lying, still manipulating, still living in the same environment, still using secretly, then medication becomes part of the cover story. The household feels calmer, the family relaxes, and the addiction continues under the surface.
Pills can also become a bargaining chip. The person says they don’t need rehab because they’re on medication now. The family wants to believe it because they want a simple fix. The reality is that medication does not rebuild trust, does not rebuild coping skills, does not rebuild routine, and does not repair relationships. Rehab is not just about stabilising mood. It is about changing behaviour and building accountability.
Medication should support the plan, not replace it.
When medication becomes substitution instead of treatment
There is a valid concern families have, that medication can become another dependency. This can happen when sedatives are used loosely, when sleep medication is relied on without a plan, or when benzodiazepines are prescribed long term to someone with addictive patterns.
A strong rehab centre understands this risk and manages it carefully. They avoid unnecessary addictive medications. They use time limited prescriptions when needed. They monitor closely. They explain the plan. They taper appropriately. They ensure the person is learning non medication coping skills alongside any medication use.
A weak programme may rely heavily on sedating medication because sedation creates the appearance of calm. A sedated person is easier to manage. A sedated person complains less. A sedated person looks like they are improving, but sedation is not the same as recovery.
Families need to be aware of this difference. If the person is sleeping all day, emotionally flat, and not engaging in therapy, medication may be masking rather than supporting.
Transparency matters
Families often complain that they don’t know what the rehab is doing. The rehab might say confidentiality. Confidentiality is real, but families still deserve general clarity about the approach, what kinds of medication might be used in detox, what the mental health plan is, and what aftercare includes.
Families should ask for clear information. What medications are typically used in detox. How long are they used. What is the monitoring plan. How is sleep managed. How are anxiety symptoms managed. Who prescribes medication. How often is it reviewed. What is the discharge medication plan. What happens if the person refuses therapy but wants medication.
A good centre can explain these things without breaking confidentiality. A weak centre will hide behind vague reassurances.
The discharge problem
Many relapses happen after discharge when medication plans are unclear. The person stops medication suddenly, or continues medication without proper monitoring, or mixes medication with substances, or uses medication as a new form of avoidance. Families often assume that medication is enough to keep someone stable. It isn’t.
A strong discharge plan includes medication review, follow up appointments, therapy continuation, support group integration, and clear boundaries in the home. Medication is one tool in a bigger plan. If it becomes the only tool, the plan is fragile.
Families should also be careful about self managed medication. Addictive patterns can turn medication into misuse. If someone has a history of pill abuse, medication must be managed carefully with professional oversight.
Medication in rehab can save lives. It can stabilise dangerous withdrawal. It can reduce mental health symptoms that drive relapse. It can support medication assisted treatment for certain addictions. But medication can also hide a weak programme, create new dependency risks, and become a substitute for real behavioural change when families cling to pills as a simple fix. The key is clarity, purpose, monitoring, and a plan that includes therapy, structure, and aftercare. Families shouldn’t fear medication and they shouldn’t worship it either. They should demand a clear explanation of what is being used, why it is being used, and how it fits into a recovery plan that doesn’t end at discharge.